Is ondansetron a less effective antiemetic against moderately emetic as compared with highly emetic chemotherapy?

The severity of sickness in the first 5 days after cancer chemotherapy was compared in patients who had or had not received ondansetron 8 mg three times daily. Patients were divided into those having highly emetic chemotherapy, irrespective of gender and women having moderately emetic drugs. Ondansetron appeared to be more effective in the former group.

Local anesthesia blocks the antiemetic action of P6 acupuncture.

The incidence of postoperative illness was monitored for 6 hours in 74 women premedicated with nalbuphine, 10 mg, and undergoing short gynecologic operations of similar duration under methohexitalnitrous oxide-oxygen anesthesia. Each patient received P6 acupuncture for 5 minutes at the time of administration of premedication. In random order the site of the acupuncture had been previously infiltrated with normal saline solution in half of the patients and 1% lidocaine in the remaining patients. Postoperative emetic sequelae occurred significantly more often in those who received lidocaine compared with the group that received saline solution. This demonstrates the ability of a local anesthetic administered at the point of stimulation to block the antiemetic action of P6 acupuncture in a manner similar to that shown by others for analgesia.

Non-invasive stimulation of the P6 (Neiguan) antiemetic acupuncture point in cancer chemotherapy.

The beneficial effects of transcutaneous electrical stimulation of the P6 antiemetic point (Neiguan) as an adjuvant to standard antiemetics was studied in over 100 patients in whom chemotherapy-induced sickness was not adequately controlled by antiemetics alone. Although the results were not quite as good as with invasive acupuncture, more than 75% patients achieved considerable benefit from what was a non-toxic procedure. The use of large diffuse low impedence electrodes simplifies the technique. The 2 hourly application of Sea Bands prolongs the antiemetic action. Best results were obtained from the 2 hourly self-administration of 5 min of transcutaneous electrical stimulation of P6 using a simple battery-operated TENS machine (15 Hz) to activate a large, easy-to-place surface electrode and increasing current until Qi is elicited.

Prolongation of the antiemetic action of P6 acupuncture by acupressure in patients having cancer chemotherapy.

Previous work from our department has shown that P6 acupuncture is an effective adjuvant to conventional antiemetic therapy for patients having cytotoxic drugs. However, its efficacy is limited to about 8 h. The current studies show that the application of an elasticized wrist band with a stud placed over the acupuncture point, and pressed regularly every 2 h, will prolong the antiemetic action for 24 h. This proved more effective in hospitalized patients (20/20) than in outpatients (15/20), presumably due to the encouragement given to regularly press the stud. Nausea and vomiting remain problems with cancer chemotherapy despite the use of antiemetics. Following encouraging results with P6 acupuncture (ACP) in postoperative sickness this has been shown to be effective in cancer chemotherapy in 105 patients who, despite the use of conventional antiemetics had been sick following the previous treatment. Electrical stimulation (10 Hz DC) of P6 point for 5 min before administration of the cytotoxic drugs was effective in preventing sickness in 66% and only 6% got no benefit. The ACP was given with the antiemetics which the patients had been receiving. Although there were no side effects with the ACP, the benefit only lasted 6-8 h. This was not important in hospitalized patients where the treatment could be repeated, but was a problem with outpatients. It has been shown that pressure on the P6 point (acupressure) has an antiemetic action. A commercially available elasticized band with a plastic stud (Sea Band) is an effective method of applying pressure to P6 point.(ABSTRACT TRUNCATED AT 250 WORDS)

Belfast experience with P6 acupuncture antiemesis.

In a strictly controlled clinical situation, (postoperative sickness) where variables were reduced to a minimum, it was possible to demonstrate an effective prophylactic antiemetic action of P6 (Neiguan) acupuncture. Manual and electrical invasive (needling) stimulation of this point were equally effective. Non-invasive stimulation (transcutaneous electrical or pressure) was effective in the early postoperative period, but the effect did not last as long as for invasive acupuncture--although it was as good as standard antiemetics. Stimulation of a "dummy" acupuncture point was ineffective as was administration of the acupuncture after the emetic stimulus (opioid). This effect can be blocked by local anaesthesia at the P6 point. Acupressure (P6) is moderately effective in reducing morning sickness, but here there is more of a psychological element as pressure on a "dummy" point gives some alleviation of symptoms. Given in conjunction with standard antiemetics, P6 acupuncture is a useful adjuvant in reducing sickness after cancer chemotherapy. This effect can be prolonged for 24 hours by acupressure.

Fantasies during sedation with intravenous midazolam or diazepam.

Details are reported of 41 incidents where women reported fantasies during sedation with IV midazolam or diazepam: 27 of them had some sexual element and 20 were unpleasant experiences. The events occurred in a logical sequence and all were certain of their authenticity. Some led to litigation against the sedationist. Out of 25 verified reports made by patients of incidents occurring during sedation, 17 did not happen and in 9/13 clear descriptions there was some relation between the fantasy and something that really happened under sedation. All occurred with what are now considered large doses of the drugs. During or following sedation lady patients should not be treated or examined without the presence of a responsible third person. The use of the injectable benzodiazepines, diazepam and more recently midazolam, with their sedative, amnesic and relaxing properties have made unpleasant operative procedures, particularly those usually carried out under local analgesia, more acceptable to many patients. These include oral endoscopy and dental procedures and operations under spinal or epidural analgesia. These drugs also provide good sedation during ventilatory support and in the intensive care unit. Over a long period of time these benzodiazepines have proven to be, in appropriate doses, among the safest in medicine for short term use. There have however been a few cases of what can be described as "fantasies" occurring during sedation: events occurring in a logical sequence which are very real to the patient and yet, on the evidence of two or more independent witnesses, did not occur. Many of these have had an element of sexual trespass.(ABSTRACT TRUNCATED AT 250 WORDS)